Q and A about FSH and IUI

Ah, more alphabet soup! And more blogging from me (can you tell that I'm done with school for the summer?) - I've had a lot going on recently.

Luckily, the injections worked! Well, insofar as they produced four follicles. Before starting this cycle, I knew basically nothing about how this all worked - so I thought I'd share what I've learned this week.

1) What is FSH with IUI?
My insurer requires that I do two cycles of IUI (intrauterine insemination) with FSH injectibles before I can do IVF. My doctor says this is a waste of time (see below, #2).

2) What is the success rate of IUI with FSH?
For me (no known problems, and husband with excellent sperm counts and motility) apparently it's about 20% per cycle. This means that after two cycles of FSH with IUI, 36 out of 100 women will be pregnant (20% the first month, and 20% of the remaining 80 the next month). Clomid with IUI was about 10% per month for me, which means that after three months (I did three cycles) of Clomid with IUI, 27 out of 100 women will be pregnant.

3) What is FSH with IUI?
FSH is follicle stimulating hormone, and I get it via injection. I use the Gonal-F pen, and started injecting myself once a day (they tell you to do it between 5 and 10 p.m. and I've been doing it at about 10:30). It looks like a pen - and you just push it onto a needle (it's short, and skinny, not that bad) and then inject the dosage that your doctor prescribed (mine was 112). Then you inject yourself in the thigh or stomach (they told me to do it in the stomach).
You do this starting on day 3 of your cycle, and on day 7, they started giving me blood tests and ultrasounds. Once follicles are the right size (see #4 below) I give myself a HCG shot, which induces ovulation. On the next two days, we'll take a sperm sample to the lab, where they'll "spin" it, and then inject it directly into my uterus (painless - unless you're in the 1% of women who have a prostaglandin reaction - which I am - and then you'll have very bad cramping for about 3 hours after the IUI. They can improve that by washing the sperm twice - which they did for me last time, and I had almost no cramps!).

4) How many follicles are you supposed to produce and what size should they be?
According to my nurse (and the internet) they like to see about 4 follicles for an IUI cycle. Any more just increases the risk of multiples, and doesn't improve pregnancy rates. They like the follices to be close to 20 mm (or at least for the largest one to be). Follicles are the little sacs that the eggs sit in - without drugs you'll usually produce one per cycle.

They see and measure the follicles via ultrasounds (not the over the belly type either - this is a nice wand that goes...guess where?). They measure your estrogen level by taking blood.

So for me, today (day 8 of my cycle) I had one follicle that was 18 mm, one that was 16 mm, one that was 14 mm and one that was 13 mm. I had two on each side. My estrogen level was 568 (what?) - apparently it's about 200 per mature follicle. So I'll do another shot tonight, and assuming the follicles grow at the rate they have been (about 3 mm per day for me) tomorrow I'll have a 21, 19, 17 and 16 and by the time I take the HcG shot, they'll be a little bigger.

The needle for the HcG shot is a little scarier, but like I've said before, you can pretty much do anything you set your mind to...

My last question is whether my total cycle length will be shorter (for vacation planning purposes of course! You can't really leave your doctor's neighborhood during days 7 - 14 or whenever you are ready for ovulation and IUI). I usually ovulate on day 15 of my cycle, and get my period exactly 14 days later. This time I'll be inducing ovulation on day 10 of my cycle - so based on me in the past, I should get my period on day 24.

Do you care? No way. Unless you're about to go through this, in which case, you're probably like me - googling "FSH and IUI" to death.

Hopefully this was helpful...and hopefully I'll be in that elusive 20% this month.
- L.